title: Tenofovir as rescue therapy following clinical failure to Lamivudine in severe acute hepatitis B.
abstract: Acute hepatitis B (AHB) is a self-limiting condition in more than 95% of cases. Treatment is however recommended in patients with severe AHB (<1% of cases), aiming to prevent liver failure and death. Various nucleos(t)ide analogues (NA) have been found to be effective in severe AHB, although NA-resistant strains causing AHB have been also recently reported. The use of tenofovir in severe AHB has only been described in 3 cases (1 adult and 1 infant with HBV mono-infection, 1 adult with HBV/HIV co-infection). We hereby report a 47-year-old treatment-naïve male, who developed severe AHB and was initially treated with lamivudine (LMV). Initial rapid biochemical response was followed by biochemical breakthrough after 9 days, suggesting LMV resistance. Rescue therapy with 'add-on' tenofovir brought about a sustained improvement in biochemical, serological and virological markers until HBsAg was lost after 4 months. Thus, this is the second adult HBV mono-infected patient, who responded successfully to tenofovir in severe AHB.
authors.affiliation: Division of Gastroenterology, Mater Dei Hospital, Malta.
authors.forename: Jurgen
authors.initials: J
authors.lastname: Gerada
authors.forename: Elaine
authors.initials: E
authors.lastname: Borg
authors.forename: Denise
authors.initials: D
authors.lastname: Formosa
authors.forename: Rosalie
authors.initials: R
authors.lastname: Magro
authors.forename: James
authors.initials: J
authors.lastname: Pocock